Usage
This combination medication is primarily prescribed for symptomatic relief of cough and cold symptoms, particularly those associated with allergies. It addresses multiple symptoms simultaneously due to its multi-component formulation.
Pharmacological Classifications:
- Antihistamine (Cetirizine): Reduces allergic symptoms like sneezing, runny nose, and itchy eyes.
- Cough Suppressant (Dextromethorphan Hydrobromide): Suppresses the cough reflex.
- Expectorant (Ammonium Chloride): Thins and loosens mucus, facilitating its expulsion.
- Topical Analgesic/Counterirritant (Menthol): Soothes throat irritation and provides a cooling sensation.
- Zinc supplement (Zinc Gluconate): May potentially reduce duration and severity of cold.
Alternate Names
- Cromocet-DZ Syrup Mango
- Ariwa Syrup
- Other brand names may exist.
How It Works
Pharmacodynamics:
- Cetirizine: A second-generation H1 receptor antagonist, it competitively inhibits histamine binding, reducing allergic manifestations.
- Dextromethorphan Hydrobromide: NMDA receptor antagonist to suppresses the cough reflex in the medulla.
- Ammonium Chloride: Increases respiratory tract fluid, thinning mucus and aiding expectoration. May also act as a weak acidifying agent.
- Menthol: Activates TRPM8 receptors causing a cooling sensation. Also exerts mild local anesthetic and antitussive effects.
- Zinc Gluconate: May interfere with viral replication, potentially affecting cold duration, though evidence is limited.
Pharmacokinetics:
- Cetirizine: Well-absorbed orally. Peak plasma concentrations reached in approximately 1 hour. Metabolized minimally. Excreted primarily unchanged in urine.
- Dextromethorphan Hydrobromide: Readily absorbed from the gastrointestinal tract. Extensively metabolized in the liver, primarily by CYP2D6. Excreted in urine as metabolites.
- Ammonium Chloride: Absorbed from the gastrointestinal tract and excreted renally
- Menthol: Absorbed through skin and mucous membranes. Metabolized in the liver. Excreted in urine and bile.
- Zinc Gluconate: Absorption and kinetics vary depending on the zinc salt and formulation, however the majority of zinc is excreted in the faeces.
Dosage
Standard Dosage
Adults:
- Typically, 5-10 ml of syrup every 4-6 hours as needed. Maximum daily dose should not exceed 40 ml. This is a general guideline, always follow the prescribed dosage by a physician.
Children:
- Dosage is dependent on age and weight and should be determined by a physician. This combination is generally not recommended for children under 2 years of age.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary due to age-related decline in renal and hepatic function.
- Patients with Renal Impairment: Dose reduction is necessary depending on the degree of impairment.
- Patients with Hepatic Dysfunction: Caution is advised, and dose adjustment may be required.
- Patients with Comorbid Conditions: Individualized assessment is essential, considering the patient’s overall health status and potential drug interactions.
Clinical Use Cases
This combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. It’s primarily intended for outpatient management of common cold and cough symptoms.
Dosage Adjustments
Dose modifications are based on renal/hepatic function, age, and other relevant clinical factors. Consult specialized resources or a pharmacist for precise dosage recommendations in specific cases.
Side Effects
Common Side Effects:
- Drowsiness
- Dry mouth
- Nausea
- Constipation
- Dizziness
- Headache
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling)
- Difficulty breathing
- Confusion
- Hallucinations
- Seizures
Long-Term Effects:
Chronic complications are unlikely with short-term use. Prolonged use of dextromethorphan at high doses can be associated with neurotoxicity.
Adverse Drug Reactions (ADR):
Significant ADRs are rare but require prompt medical attention if they occur.
Contraindications
- Hypersensitivity to any of the ingredients
- Concurrent use of MAOIs
- Severe respiratory impairment
- Severe hepatic or renal impairment
Drug Interactions
- MAOIs: Concomitant use with dextromethorphan can precipitate serotonin syndrome.
- Alcohol and CNS Depressants: Additive sedative effects.
- Anticholinergic Drugs: May potentiate anticholinergic effects.
- Other medications: Consult drug interaction resources for a comprehensive list.
Pregnancy and Breastfeeding
Consult a physician before using this medicine during pregnancy or while breastfeeding. Limited data are available regarding the safety of this combination in these populations.
Drug Profile Summary
- Mechanism of Action: See “How It Works” section.
- Side Effects: See “Side Effects” section.
- Contraindications: See “Contraindications” section.
- Drug Interactions: See “Drug Interactions” section.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: See “Dosage” section.
- Monitoring Parameters: Observe for adverse reactions, especially in patients with pre-existing conditions.
Popular Combinations
This combination is typically used as a stand-alone formulation.
Precautions
- General Precautions: Assess for allergies, renal/hepatic function, and other relevant medical conditions before prescribing.
- Specific Populations: Exercise caution in pregnant or breastfeeding women, children, and the elderly. Individualized assessment is crucial.
- Lifestyle Considerations: Advise patients to avoid alcohol and activities requiring alertness while taking this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Cetirizine + Dextromethorphan Hydrobromide + Menthol + Zinc Gluconate?
A: See “Dosage” section for details. Always refer to the specific product label for instructions and consult a doctor for personalized recommendations.
Q2: Can this combination be used in children?
A: Some formulations are suitable for children, but age and weight-based dosing is crucial. Consult a pediatrician.
Q3: Can pregnant or breastfeeding women use this combination?
A: Consult a physician before use during pregnancy or breastfeeding. Safety in these populations is not fully established.
Q4: What are the common side effects?
A: Drowsiness, dry mouth, nausea, and constipation are common.
Q5: Are there any serious side effects?
A: Serious side effects are rare but can include allergic reactions, difficulty breathing, and seizures.
Q6: What are the contraindications?
A: Hypersensitivity, concurrent MAOI use, severe respiratory or hepatic/renal impairment are contraindications.
Q7: Does this combination interact with other medications?
A: Yes, potential interactions exist with MAOIs, alcohol, CNS depressants, and anticholinergics. Consult resources for details.
Q8: What should patients be advised regarding lifestyle precautions?
A: Avoid alcohol and activities requiring alertness.
Q9: What is the role of zinc gluconate in this combination?
A: Zinc gluconate is included as a source of zinc but the benefits in this indication remain largely unsubstantiated.
Q10: What is the duration of treatment?
A: This medication is intended for short-term symptomatic relief. Consult a physician if symptoms persist.
